| NPI | 1972789345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: VT 089.0074343) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: OR 4064) |
| Enumeration Date | 2008-01-16 |
| Last Update Date | 2011-01-20 |